Penn and Russian doctors explore a cool surgical procedure

By SANDY SMITH

A team of Russian physicians visited the Medical Center this month with news about an open-heart surgical procedure that leaves patients cold. The news and the team were warmly received by their Penn anesthesia department hosts, who have received a University grant to begin a collaborative research project with the Russian doctors.

A Siberian patient is iced prior to open-heart surgery as Russian doctors Dmitri Guvanov and Vladimir Lomivorotov and Assistant Anesthesia Professor Stuart Weiss observe. Guvanov is currently a research fellow in Penn's anesthesia department.

The physicians hailed from the Novosibirsk Institute of Circulatory Pathology, where for years doctors have been conducting open-heart surgery without heart-lung bypass machines. Vladimir Lomivorotov, M.D., the institute's chief cardiothoracic anesthesiologist, explained through a translator, "The procedure is quite different from the conventional approach to providing cardiothoracic surgery" in the rest of the world.

In order to operate on the heart, doctors must stop it so they can make the precise incisions needed to repair heart defects. Doing so, however, cuts off the blood flow and oxygen supply to other organs, which can cause permanent damage and even death. "The brain will only survive for three to five minutes at most without blood flow," said Assistant Professor of Anesthesia Albert Cheung.

To prevent this, one of two things must happen: either blood must keep flowing or the body's need for oxygen must be reduced.

Heart surgeons in the West have traditionally opted for the former by using a heart-lung machine, which may cause blood clotting or inflamation. The Novosibirsk method takes the latter approach: it cools the patient's body temperature until it enters suspended animation, a condition known as hypothermia.
"The temperature of the patient's brain is so low that it actually allows you to stop the heart for a sufficient time -- up to an hour and 30 minutes -- to restore the heart defect, restore the circulation afterwards, and restore the full functioning of the brain," Lomivorotov said.

Lomivorotov first described the procedure to Penn anesthesiologists in a talk last October. "The results of the procedure are comparable to what we routinely do here using heart-lung machines," but at a lower cost, Cheung said.

The procedure was actually first used in Japan and England more than 40 years ago, but was largely abandoned after the introduction of bypass machines. Novosibirsk Institute Executive Director Alexandr Karaskov explained that his institute was the only center in the world that continued to actively use and refine the procedure.

"We have refined [it] to the point where it can be safely done without damaging the patient," he said.

The Russians also hope to learn from their American counterparts. The Novosibirsk Institute plans to refashion itself as an academic medical center similar to Penn's Health System, and the delegation included an economist, Larissa Shkhrko, Ph.D., who is studying aspects of the American health system that could be adapted to Russia's changing health-care environment.

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